Orientation for Faculty and Students
Anesthesia Attestation Form

Statement:

I have read and understand the UMMC Orientation information. I understand that I am required to comply with all hospital policies and the directions of the supervising physician, nurse or other personnel. Furthermore, I understand that I am required to maintain confidentiality of all patient information to which I have access.

I understand that I will not be considered to be an employee of UMMC and agree that I will not be compensated financially. I also understand that I am not entitled to any benefits available to UMMC employees.

I will conduct myself in a professional manner at all times while on the UMMC campus and will support the hospital's mission of providing model care.

Name:*

Department or School:*

By checking the following box, you are electronically signing this document:*

Signed

Date:*

Information Policy Agreement

As an individual having access to University of Mississippi Medical Center (UMMC) information on or off campus, I agree and abide by the UMMC Information Policy and all other institutional policies. I understand that non-compliance will be cause for disciplinary action up to and including system privilege revocation, dismissal from UMMC, and possible criminal and/or civil penalties.

Name:*

Department or School:*

Student ID #*

By checking the following box, you are electronically signing this document:*